D.C. HEALTH CARE_CONDITION CRITICAL

October 28, 1990

As Election Day nears in the District, we hear little about our health care system from the mayoral candidates.

Sharon Pratt Dixon and Maurice Turner debate the need for a new football stadium, but they don't deal with the fact that the number of patients treated each year by D.C. hospitals and clinics would fill the stadium many times over.

They announce plans for dealing with the city's infamous crime rate, but don't discuss how we will be able to afford treatment for those injured in the drug wars.

But the candidates should be addressing the fact that the city's health care system is in critical condition and its populace beleaguered. The District has an infant mortality rate that rivals that of the Third World and an alarming number of childhood deaths from intentional injury. It has a disturbingly high incidences of preventable heart disease and cancers, yet its under-funded clinics and prevention programs have been the first to be cut in tight financial times.

If elected, what would the candidates do about the 40 percent of D.C. citizens who have little or no health insurance, who therefore put off seeking care until they become critically ill and end up in the city's emergency rooms? Our ERs are overflowing, and all patients face long delays in treatment. The critically ill wait for beds filled by those needing unavailable long-term care, while people needing elective procedures vie for the same beds.

D.C. General, our public hospital, is overburdened and chronically under-funded. Consequently, the city's private hospitals have had to assume a greater responsibility for treating patients who cannot pay. Providing too much free care, however, can kill a hospital -- Howard University Hospital has laid off hundreds of workers, Capitol Hill Hospital may soon close as an acute-care facility and other institutions may be forced to take equally drastic measures.

Our hospitals are caught between a rock and a hard place: they must maintain their financial viability while trying to serve the increasingly critical needs of an impoverished populace. Many medical facilities are promoting their services to suburban populations in an attempt to garner a greater share of patients with insurance or the financial means to pay for care. But surely the District's interests are not best served by health care providers whose financial survival depends on wooing suburbanites and limiting services to city residents who cannot pay. That is medical apartheid.

Affordable, accessible health care is not solely the government's responsibility, of course. Incompetent hospital managers and greedy physicians share the blame for the inadequacies of our existing system. But D.C. government is at fault when it fosters policies that do not pay the private institutions' cost of treating the poor people the city has neglected.

We prescribe the following treatment for our ailing system:

A health department separate from the Department of Human Services and directed by a cabinet-level commissioner who would report directly to the mayor.

A cost-review commission to scrutinize and set reasonable charges for services at private hospitals. Establishing an "all-payer" system for hospital reimbursement would allow hospital charges to be adjusted to cover the uncompensated care the hospitals provide. This would ensure equal access to care and nondiscrimination in treatment for all patients, regardless of ability to pay.

A partnership between the public and private sectors to find innovative ways of providing critical medical services the city can't afford.

A limitation on monetary awards plaintiffs can recover in malpractice suits. Unreasonably high jury awards increase the cost of care and make providers wary of practicing in the District and reluctant to care for high-risk patients.

The city's new mayor can continue a legacy of medical indifference or provide the leadership that will ensure that all citizens receive adequate medical treatment. The voters should be asking the candidates which they intend to do. -- Howard R. Champion -- Patricia S. Gainer are, respectively, director of MedSTAR, Emergency and Trauma Services at the Washington Hospital Center, and director of MedSTAR's Washington Community Violence Prevention Program. These are their personal views.